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Optimal initial management of the trauma patient during the first several hours after injury offers the best chance of a good outcome. Patient management consists of rapid primary survey, resuscitation of vital functions, a more detailed secondary assessment, diagnostic tests to ascertain the extent of traumatic injury and finally, the initiation of definitive care.
This chapter discusses the management of trauma. The primary survey for a trauma patient is performed with regard to airway, breathing and circulation. Several airway adjuncts are available to assist in endotracheal intubation, including the gum elastic bougie, supraglottic airway devices, videolaryngoscopy, or fiberoptic scopes. The breathing evaluation include visualization of chest rise, auscultation of breath sounds, palpation of the chest wall feeling for crepitus or flail segments, and assuring that the trachea is midline. The patient is examined for signs of hemorrhage, including all compartments that can hold life-threatening amounts of blood loss. Evaluation for disability in the primary survey should include Glasgow Coma Scale (GCS), neurological examination to rule out neurological deficit, and pupil examination for signs of intracranial injury. Emergency department thoracotomy (EDT) is a resuscitative procedure that has low survival rate and should be performed in unique circumstances.